Patient Guide to Dental Insurance

To Our Valued Patients:

 

As dentistry continues to offer new opportunities and choices to patients, we continue to experience dramatic changes and reductions in dental benefit coverage. 

  

We consider our relationship with you to be of primary importance and will always make our recommendations to you based on what we believe is the very best treatment for you regardless of your insurance coverage. As a concerned partner in your dental well-being, we do not want to compromise your care based on restraints placed by an insurance company. Our goal is to help you achieve and maintain optimal dental care, which is not necessarily the goal of your insurance company. 
 

Furthermore, with the introduction of the "Privacy Act" by both the Federal and Provincial Governments, many insurance companies are reluctant to speak/deal directly with dental offices and are very reluctant to disclose policy/financial details to the dental staff. This makes it extremely difficult for us to deal with insurance companies. For this reason we ask for your understanding if we are unable to provide financial details pertaining to your insurance at the time treatment is recommended.

  

Concerning your insurance policy, please be aware of the following: 

  • Dental benefits are a contract between the patient and their employer/dental benefit company, not the dentist. It is your benefit.
  • Often cheques are being sent directly to patients, not the dentist
  • Dental insurance companies do not inform dental practices of any changes to your benefit plans.
  • Dental insurance companies often refuse to give dental practices information in order to protect the patient's privacy.
  • Dental benefits, in many cases, do not cover 100% of the current, suggested fee guide.
  • 

How We Can Help You  

We encourage our patients to be familiar with their dental plans to eliminate disappointment with payment for necessary treatments that may only be partially covered or not covered at all. Please make certain that the insurance information we have on file is always current.

  

Upon request, we can help you understand and make the most of your dental insurance benefits if you provide us with your policy information. As a courtesy to you, our office will submit your claims to your insurance carrier. We offer electronic submission (EDI) where possible to expedite the claim process. Most payments are processed in a few days rather than a few weeks. We want to help you achieve the maximum reimbursement to which you are entitled and will work diligently to make this happen as quickly as possible. We may request your assistance in contacting and speaking with your insurer if, by policy, they refuse to divulge information to us.
 

 

Assignment of benefit is accepted provided that:

  • The appropriate insurance benefit information can be obtained before your appointment and that you update our records when your benefit information changes.
  • Amounts not covered by the insurance company are to be paid in full at the time of the appointment after treatment is received.
  • Any insurance payments that are mailed directly to you are brought into our office promptly.
Pre-Determination Policies

Many insurance companies require authorization for specific procedures in advance.  Naturally, we always provide you with the full fees in advance so that you know the exact cost of treatment. We will send a detailed estimate or pre-determination to the insurance carrier(s) involved. In most cases, the response is sent to the insured / employee within 2-3 weeks. Please look for it in your mail or online and notify us when you have received your pre-determination, so that we may book the necessary appointments and expedite your treatment. However; patients need to understand that in the event the insurance company refuses to pay for treatment, you are responsible for all fees.
 

 

Fees
The current Ontario Dental Association Suggested Fee Guide is the basis for our fees. We can provide a written treatment plan with fee estimate directly to the patient and/or to the dental insurance company.
  
Methods of Payment Accepted
Payments can be made by cash, debit, Visa, Mastercard, AMEX or by payment directly from your insurance company. Please note that you are responsible for any difference not covered by your insurance company.
 
Ask Us For Help Any Time
Any time you have a question about your dental insurance, please feel free to ask us. It will be our pleasure to help you. We are dedicated to providing optimal care for every patient and working with you to achieve that goal.

 

                                       

 

Your account remains your responsibility
phone:
905 576-4537